If you’re new to Medicare, you may be asking, “Does Medicare cover mental health testing and treatment?” Yes, Medicare covers mental health and helps pay for many services. This article will take a look at all of your Medicare mental health coverage services.
does medicare cover mental health?
Yes, Medicare provides mental health coverage.
Medicare will help cover and pay for a variety of inpatient and outpatient mental health tests and treatments. These services also include help with alcohol and drug use. These services are covered under Part A (inpatient hospital) and Part B (outpatient treatment).
medicare mental health coverage
Below is a breakdown of your healthcare costs. It’s important to review what mental health services are covered. Below, you’ll find what is covered under:
What are my costs with Original Medicare?
With Original Medicare, you’ll pay nothing for an annual depression screening when your health care provider or physician accepts assignment.
- You will be responsible to pay 20% of the Medicare-approved amount for any visits to your health care provider or physician to treat or diagnose your mental health condition. Your Medicare Part B deductible will apply.
- When you receive services in a hospital outpatient clinic/department, you may be responsible for paying an extra copay or coinsurance to your hospital.
Will Medicare pay for inpatient mental health services?
Medicare Part A provides coverage for inpatient hospital mental health treatment and services.
This is typically seen in severe mental health cases where someone is dangerous to themselves or others.
Medicare Part A coverage
Your Medicare Part A provides coverage for the cost of your hospital room as well as:
- Inpatient therapy
- Lab testing & some medications
While Medicare will cover most of your inpatient mental health services, you may have to pay for some out-of-pocket costs.
This will all depend on your supplemental plan as well as how long your stay in the hospital. Let’s look at your Medicare Part A costs:
Medicare Part A Costs
- Most people don’t have a Part A premium.
- However, if you have one, it’s typically around $250-$450
- Part A deductible in 2021 is $1,484
- You’ll pay 20% for all “Medicare approved” costs during your hospital stay
- Days 1–60 of treatment: $0 coinsurance
- Days 61–90 of treatment: $352 coinsurance per day
- Days 91+: $704 coinsurance per day. (91+ through your lifetime reserve days)
- You owe 100% of treatment costs when you are beyond your lifetime reserve days
There is no limit to how much inpatient mental health care you can get in a hospital. However, Medicare Part A will only provide coverage for up to 190 days of inpatient care if you are in a psychiatric hospital.
Will Medicare pay for outpatient mental health services?
Yes. If you have Medicare Part B, you will receive coverage for a variety of mental health services. These include outpatient mental health care, yearly depression screenings and partial hospitalization.
Let’s look at your basic costs for Part B in 2021:
- $148.50 monthly premium
- $203 annual deductible
- When receiving treatment, you’re responsible to pay for 20% for all Medicare-approved costs
- When receiving mental health services from a hospital outpatient clinic, you’ll pay any coinsurance or copays.
Medicare Part B Coverage
Your Medicare Part B medical insurance will help cover your outpatient mental health services. Here are the specific services that Part B will pay for:
- One annual screening for depression. The depression screening has to be completed in your primary care doctor’s office or primary care clinic so that they are able to give you follow-up referrals and treatment.
- Group and individual psychotherapy. This treatment is provided by doctors or certain other licensed professionals who are permitted by the state where services are provided.
- Family counseling. This is covered when the primary purpose of counseling is to help with your treatment.
- Testing to identify if you’re receiving the mental health services you require and if you’re progressing with your current treatment.
- Psychiatric testing.
- Management of medication.
- Specific prescription medications, like certain injections, that typically aren’t “self administered.”
- Diagnostic testing.
- Partial hospitalizations.
- A “Welcome to Medicare” preventive visit. This one time visit goes over your entire health profile, but it includes a review of mental health and if you’re a potential risk based on factors for depression.
- An annual “Wellness” visit where you and your doctor can discuss any changes in your mental health. They can be reevaluated every year.
Inappropriate drug and alcohol use
Medicare Part B also provides outpatient mental health coverage and treatment for alcohol and drug use when it’s determined that use is “inappropriate.”
medicare mental health provider
What kind of mental health professionals are eligible to offer treatment and testing? Below, you’ll find all of the Part B providers that Medicare recognizes as professionals who are eligible to provide behavioral treatment and/or diagnostics.
- Physicians (including medical doctors & doctors of osteopathy, particularly psychiatrists)
- Physician assistants
- Independently Practicing Psychologists
- Nurse practitioners
- Certified nurse-midwives
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
Medicare will provide authorization for most of the providers above to provide Brief Intervention, Structured Assessment, and Referral to Treatment services, as permitted under your State law.
It’s very important to only use doctors and providers who take assignment. This will help you avoid any surprise bills that you may receive if they don’t take assignment.